Journal
JOURNAL OF NUTRITION
Volume 141, Issue 12, Pages 2172-2179Publisher
OXFORD UNIV PRESS
DOI: 10.3945/jn.111.142976
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Funding
- Erasmus Medical Center, Rotterdam
- Erasmus University Rotterdam
- The Netherlands Organization for Health Research and Development (ZonMw)
- Netherlands Organisation for Scientific Research
- Ministry of Health, Welfare and Sport
- Ministry of Youth and Families
- ZonMw [90700303, 916.10159]
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Maternal smoking during pregnancy leads to increased risks of neonatal complications. The use of folic acid supplements might reduce the adverse effects of smoking. We examined whether folic acid supplement use modifies the associations of maternal smoking with first trimester plasma homocysteine concentrations, fetal growth characteristics, and risks of neonatal complications. The associations were studied in 6294 mothers participating in a prospective population-based cohort study in The Netherlands. Main outcomes measurements were first trimester plasma homocysteine concentrations, fetal growth characteristics, and neonatal complications, including preterm birth, low birth weight, and small-size-for-gestational-age. Continued maternal smoking was associated with higher first trimester plasma homocysteine concentrations [difference 0.52 mu mol/L (95% range = 0.20, 2.14)1, lower third trimester fetal weight (difference -44 g (95% Cl = -57, -31)1, and birth weight [difference -148 g (95% Cl = -179, -118)]. There were significant interactions between maternal smoking and folic acid supplements on all outcome measures (all P-interaction < 0.040). Among mothers who continued smoking during pregnancy, those who did not use folic acid supplements had the highest risk of delivering a child with low birth weight (OR = 3.45 (95% Cl = 1.25, 9.54)] compared to those who did use periconceptional folic acid supplements. No significant effects were observed for the risks of preterm birth and small-size-for-gestational-age at birth. Our results suggest that some adverse effects of maternal smoking on fetal growth and neonatal outcomes might be reduced by the use of folic acid supplements. The observed interaction seems to be mainly driven by smoking in the first trimester only. J. Nutr. 141: 2172-2179, 2011.
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